An Allergy Survival Guide

by Marcia Dettloff, OD on March 17, 2012

For people that suffer from seasonal allergies those beautiful flowering trees and bushes that bloom in the spring often signal the onset of weeks or months of misery. Our immune system generally acts to protect us from foreign pathogens and toxins. But in allergic reactions, the immune system runs amok and starts reacting to things that don’t pose a threat.

Mast cells are filled with histamine granules and are concentrated in blood vessels and in the mucous membranes of the eyes, nose, mouth and throat. These same tissues also have a lot of blood vessels close to the surface providing easy access for allergens. When mast cells encounter an allergen they release their histamine granules which trigger inflammation and result in the classic symptoms of itchy/watery eyes, puffy lids, runny nose, sneezing and sinus trouble.

The first key to allergy survival is to minimize your exposure to allergens in the first place. Short of locking yourself in a hermetically sealed room, it’s practically impossible to avoid allergens here in NC but there are several things you can do to minimize your exposure:
• Wear sunglasses and a hat outdoors. They not only block harmful UV rays that increase your risk of cataracts and macular degeneration but also prevent allergens from getting into your eyes and hair. Believe it or not, the much maligned yellow pine pollen that will soon be blanketing our cars (and everything else) is too big and heavy to cause allergy symptoms for most people However the sheer volume and larger size of the pollen that our pine trees release can still cause significant eye irritation, especially for patients wearing rigid gas permeable contact lenses.
• Be sure to follow your eye doctor’s recommendations for treatment of dry eye problems. A good tear film helps flush allergens from the eyes.
• You may need to clean or replace your contact lenses more frequently during allergy season. Soft lenses can absorb allergens when you are outdoors and slowly release them into your tears throughout the day. Your eyes also tend to produce more mucous which can coat the lenses faster.
• Change your clothes and rinse your face and eyes (if not a full shower) after being outdoors for an extended time.
• Hair is like a magnet for allergens so wash your hair at night or cover it while you are sleeping so that you don’t transfer the allergens to your pillow and bury your face in them all night long.
• Wash your sheets and pillowcases regularly.
• Keep your windows and doors closed and stay inside when pollen and mold counts are high.
• Use the dryer instead of hanging clothes outside to dry.
• Change your air conditioning filters regularly and consider an indoor air filter.

So what do you do if your allergies are getting the best of you despite your best attempts at prevention?

If your whole head is suffering, a non-sedating oral anti-histamine like Claritin, Zyrtec or Allegra is probably a good place to start. Decongestants can also be beneficial but have more side effects and should be avoided in patients with hypertension and certain types of glaucoma. Acetaminophen can cause liver damage in relatively low dosages so avoid using acetaminophen (Tylenol) for pain or headache along with a combination product that contains acetaminophen and never drink alcohol when taking acetaminophen.

If you can get past the gross factor, I know many people with sinus problems that swear by nasal irrigation with a neti pot to clear their sinuses. This video with Oprah and Dr Oz shows the procedure in action and has some testimonials and here are some tips on using the neti pot. While safe and effective with proper use, this article discusses the recently publicized scare over two deaths attributed to the rare Naegleria fowleri amoeba from using contaminated water in a neti pot.

Some patients with chronic or severe allergies may benefit from immunotherapy with allergy shots. These injections start with trace amounts of allergen and gradually increase the your exposure over several months or years to gradually desensitize your immune system to the allergen.

If your allergies primarily affect your eyes or if you still have significant eye symptoms while taking oral antihistamines, an allergy eye drop that concentrates the medication in the affected area can be very effective. There are several medications, both over-the-counter (OTC) and prescription, that can used to minimize allergies symptoms. For best results schedule an appointment today so your eyes can be evaluated and we can determine the optimum treatment plan for you.

Avoid the older OTC allergy drops like Visine-A, Naphcon-A and Optcon-A that have a decongestant and antihistamine. The dose of antihistamine isn’t strong enough to block histamine, the decongestant can cause side effects and the preservatives can be toxic to the cornea when used 4 times a day as recommended. Their main benefit is in diluting the allergens in your tears. That can be achieved with less side effects by using a lubricating drop such as Theratears, Genteal, Optive, Blink or Refresh.

Mast cell stabilizers such as Alamast and Crolom are drugs that keep mast cells from releasing histamine. They are generally very safe and effective. However, since they don’t block any histamine that has already been released, they have to be on board well before your allergy symptoms begin and the drops must be used continuously (usually 4 times a day) throughout the entire allergy season to prevent symptoms.

The current workhorse treatment is from a group of ocular allergy medications that act to both stabilize mast cells AND block histamine. They are very safe for long term use and can be used regularly for prevention or on an as needed basis for symptomatic relief. Some, such as Pataday, have the added convenience of once daily dosing. Zaditor (ketitofen) is now available as a generic and OTC as Zyrtec Itchy Eyes, Claritin Eye and house brands. It tends to sting more and generally isn’t as effective as some of the other drugs in this class (which is probably why Alcon petitioned the FDA for OTC status) but it does provide adequate relief for some patients in twice a day dosing. Unfortunately, once one drug in a class is available as or OTC, insurance companies often stop covering other drugs in that class all together resulting in patients paying significantly more for the more effective prescription versions.

In cases of severe allergic reactions steroid eye drops or even oral steroids may be needed. Long term use of steroids can increase the risk of developing cataracts and glaucoma so patients on steroids should be monitored more frequently. Since steroids can mask the signs of infection and block your ability to fight infection, you should NEVER use steroid eye drops unless specifically prescribed by your doctor for that problem.

Other tips:
Never use any eye drops while wearing contacts unless approved by your eye doctor. The medication and/or preservatives can concentrate in the contact lens and become toxic to your cornea.

Don’t rub your eyes!!! I know that’s easier said than done but rubbing physically breaks down mast cells, releasing more histamine, which just makes your eyes water and itch even more.

Don’t underestimate the value of cold compresses for fast relief of itching and swelling. A plastic bag of frozen corn or peas makes a great reusable cold compress. Just make sure to mark it clearly so you don’t accidentally use it in your next pot of soup or tuna noodle casserole.

Finally, as my patients all know, I am a big proponent of maintaining adequate Vitamin D levels. Recent studies from Pittsburgh General Hospital and Harvard have found an association between low Vitamin D levels in children and increased incidence of allergies and asthma. My family started supplementing in Vit D in November of 2010. After allergy season was over last year I realized that we didn’t seem to have as many complaints as usual in the spring or fall. My spring allergies typically hit now when the Bradford pears are in bloom and I’ve been doing pretty well so far. It will be interesting to see if my husband avoids his severe sneezing fits that usually hit later in the spring.

Now that you know how to tackle your allergies, be sure to get outdoors and enjoy this beautiful weather.